How is pediatric hypoglycemia treated?

Short-term treatment of hypoglycemia consists of an intravenous (IV) bolus of dextrose 10% 2.5 mL/kg. The critical sample should be drawn before the glucose is administered. After the bolus is administered, an IV infusion that matches normal hepatic glucose production (approximately 5-8 mg/kg/min in an infant and about 3-5 mg/kg/min in an older child) should be continued. This should be adjusted to maintain the plasma glucose level at more than 3 mmol/L. Children with hyperinsulinemia may have much higher needs. Glucagon infusion at rates of 0.005-0.02 mg/kg/h should be used as a temporary treatment in children with hyperinsulinism in whom adequate amounts of dextrose cannot be given. It can cause a rash and decreased appetite if used over the long term.

Long-term care of children with hypoglycemia varies based on the etiology.

In infants with one of several disorders (eg, ketotic hypoglycemia, glycogen-storage disorder, free fatty acid metabolism defect, mild hyperinsulinism), hypoglycemia can be prevented with frequent feedings involving a specifically designed diet and a rapid response with parenteral dextrose when feeding is inadequate because of GI problems or other illnesses. Fructose must be avoided in children with fructose diphosphatase deficiency.

A hierarchical approach is used to treat hyperinsulinism. The first step is usually frequent feeding. The next step is typically the administration of diazoxide. Octreotide is usually the second-line medical therapy. The calcium channel blocker nifedipine is also useful. Surgery is recommended if these treatments fail or if an insulin-producing tumor is suspected. Surgery is a first-line option in infants with persistent hyperinsulinemic hypoglycemia of infancy with documented focal lesions that can be removed without complete pancreatectomy. (See Pancreatic Surgery.)

Growth hormone and cortisol replacement are specific treatments for children with hypoglycemia and hypopituitarism or adrenal insufficiency.

Infants who are born prematurely and those who are small for their gestational age should be given IV or oral feedings shortly after birth to prevent hypoglycemia.

A study by LeBlanc et al reported that after implementation of a quality-improvement initiative for neonates with at least one risk factor for hypoglycemia, which included the promotion of early skin-to-skin care, early breastfeeding, and, at 90 minutes, measurement of blood glucose in asymptomatic infants, the transfer rate for at-risk infants to the neonatal intensive care unit fell from 17% to 3%. Infants in the study were born at or after 35 weeks’ gestation.
[16]

Tables

Contributor Information and Disclosures

Author

Robert P Hoffman, MD Professor and Program Director, Department of Pediatrics, Ohio State University College of Medicine; Pediatric Endocrinologist, Division of Pediatric, Endocrinology, Diabetes, and Metabolism, Nationwide Children's Hospital